Case Reports in Obstetrics and Gynecology最新文献

This case report highlights the cornerstone role played by hysteroscopy to confirm a diagnosis of uterine arteriovenous malformations that was ambiguous with the imaging studies. A 30-year-old nulliparous woman who experienced three unexplained recurrent pregnancy losses was suspected of having a uterine arteriovenous malformation. The arteriovenous malformation was confirmed through hysteroscopy and managed with a multidisciplinary approach involving interventional radiology and reproductive specialists. The hysteroscopy was followed by uterine artery embolization, which resulted in the resolution of the arteriovenous malformation. A spontaneous pregnancy and live birth rapidly followed. Uterine arteriovenous malformations have been widely reported in gynecology as a consequence of the surgical treatment of a miscarriage or gestational trophoblastic disease. We suggest that they are also important to diagnose in patients presenting with recurrent pregnancy loss, where they represent a curable etiology.

Background: Advanced stages of ovarian clear cell carcinoma have poorer prognoses than many other ovarian cancers. When standard treatments are ineffective, alternative options are needed. Case: A 56-year-old woman was diagnosed with ovarian clear cell carcinoma and treated with surgical management as well as carboplatin and paclitaxel. At recurrence, her disease progressed despite multiple chemotherapy regimens. A durable response was achieved first with alpelisib, chosen based on genomic testing. When progression occurred on this agent, a partial disease response was achieved with the combination of nivolumab and ipilimumab. Conclusion: The use of targeted therapies as well as the combination of nivolumab and ipilimumab is a promising option in advanced and recurrent cases of ovarian clear cell carcinoma.

Endometriotic cysts are common, but bilateral giant endometriosis cyst with asymptomatic cases are extremely rare. Rupture is also uncommon, yet when it occurs, it can mimic appendicitis or ectopic pregnancy due to peritoneal irritation, often requiring emergency intervention. A 25-year-old woman presented with nausea, vomiting, and an enlarging abdominal lump. Ultrasonography revealed bilateral ovarian cystic masses with ground glass appearances and free subhepatic fluid. Due to worsening symptoms despite initial resuscitation, emergency exploratory laparotomy was performed. Intraoperatively, a ruptured right ovarian cyst (20 × 15 × 15 cm) with extensive adhesions to the posterior uterus, rectum, and right ovarian fossa was identified, along with a left ovarian endometriotic cyst (12 × 10 × 10 cm). The patient underwent right salpingo-oophorectomy, left cystectomy, and ureterolysis. Histopathology confirmed endometriotic cysts. Rapid surgical intervention is crucial in ruptured cysts to minimize adhesion formation and preserve fertility. Postoperatively, continuous hormonal therapy, such as oral progesterone or an intrauterine device, is recommended to decrease recurrence.

A placental polyp is a retained fragment of placental tissue that can lead to postpartum hemorrhage or become a nidus for infection. Hypervascular placental polyps can pose an increased risk of life-threatening postpartum hemorrhage requiring immediate intervention. Thus, prompt recognition and appropriate management are crucial in preventing maternal morbidity and mortality. Here, we present the case of a 29-year-old patient who had a spontaneous vaginal delivery at 36-week gestation after induction of labor due to pre-eclampsia with severe features. Quantitative blood loss at delivery was 1300 mL, and the patient received uterotonic medications. Due to continued bleeding, she underwent a suction curettage with clots and retained tissue removed from the uterine fundus. The total blood loss was estimated to be 4 L, and the massive transfusion protocol was activated. On postpartum Day 1, she underwent a bilateral uterine artery embolization; however, she developed further heavy vaginal bleeding. A second suction curettage was performed after ultrasound showed hypervascular material in the uterine cavity. The patient was subsequently discharged, but represented on postpartum Day 15 with increased bleeding. Imaging again demonstrated a hypervascular intrauterine polypoid mass. The patient desired definitive management and underwent a minimally invasive total hysterectomy.

Introduction: Intrauterine insemination is a basic method of assisted reproduction. It enables direct deposition of sperm inside the uterine cavity. The complications are rare. Multiple pregnancy or ovarian hyperstimulation can occur when concomitant ovulation induction is performed. The risk of pelvic inflammatory disease due to the artificial cervical barrier breach is very low, but the possible consequences are serious. Case presentation: We present a case of recurrent pelvic inflammatory disease following consecutive intrauterine inseminations. Pelvic inflammatory disease pathophysiology and treatment approaches are discussed. Conclusion: Inflammatory complications of the IUI are rare, but the possible impact on fertility can be devastating. Prevention of the PID together with prompt diagnosis and individualized therapy should be assured to preserve fertility.

Primary endometrial squamous cell carcinoma (PESCC) is a rare pathology. Data regarding diagnosis and treatment is limited and is solely based on case reports and series. We report a unique case of a postmenopausal woman with a history of HIV and anal cancer s/p radiation therapy 8 years prior. The patient's presenting diagnosis was malodorous vaginal discharge refractory to antibiotics. The patient had a significant delay in diagnosis since the onset of symptoms despite extensive workup but eventually underwent surgical staging by gynecologic oncology with a diagnosis of Stage IB PESCC. Despite her reported history of anal cancer for which she received an incomplete course of pelvic radiation, the case was discussed at tumor board and the patient was deemed a candidate for external beam radiation therapy. In our report, we discuss, in detail, the patient's presentation, course, and treatment and review the literature.

Tension-free vaginal tape has been the gold standard for the treatment of stress urinary incontinence for over 20 years. However, rare complications like intravesical tape erosion can significantly reduce quality of life, requiring surgical removal. This procedure must preserve continence and can be challenging. We report the case of a 53-year-old woman who presented with recurrent urinary tract infections and dysuria 7 years after a TVT procedure. Imaging revealed a bladder stone attached to the eroded sling at the bladder neck, inaccessible via standard cystoscopy. A transvesical laparoscopic approach was used to successfully remove the intravesical portion of the tape. The patient recovered well and remained symptom-free and continent. Various techniques are used to perform intravesical tape resection. Transvesical laparoscopy offers excellent visualization and precise excision and minimizes recurrence risks for stress urinary incontinence. It is a safe, effective, and minimally invasive option for removing eroded tension-free vaginal tape, especially in difficult-to-access areas like the bladder neck.

We report a case of a 19-year-old diagnosed with anti-NMDAR encephalitis in relation to an immature ovarian teratoma. Ultimately, chemotherapy resulted in her improvement despite poor performance status. We provide a literature review of the published cases of anti-NMDAR encephalitis caused by immature teratomas and summarize their treatment.

Extensive and infiltrative fibrous adhesions of the uterus and ovaries to the surrounding organs make surgical interventions in endometriosis challenging. A preoperative identification of these involvements can help the surgeon better prepare for the surgery. Traditionally, ultrasonography and magnetic resonance imaging (MRI) have been used. However, clinical use of modern VR technology for creating and visualising a three-dimensional (3D) digital model for a complex surgical case has been proposed. We describe a case of a 29-year-old who presented with dyspareunia and dysmenorrhea (VAS score of 10/10) with left parametrial endometriosis and created a 3D model from their two-dimensional (2D) DICOM images. A left parametrial endometriosis nodule was identified involving the left ureter, rectum, and vaginal fornix along with mucosa. A virtual preoperative surgery was done for precise and complete excision of the disease and to prevent injury to the left ureter and rectum. The surgery was performed as a two-step excision using a da Vinci Xi robot and included left ureterolysis, shaving of the bowel endometriosis nodule and full-thickness vaginal wall excision along with the infiltrating nodule. The infiltrating endometriosis nodule was split into two halves and was excised individually. Her postoperative VAS score for dysmenorrhea was 2/10, and she is 28 weeks pregnant at the time of submission. Advanced VR imaging can help in the evaluation and management of deep endometriosis. It can improve the surgeon's understanding of the specific anatomy, visualise the disease, and improve clinical outcomes.

After diagnosing brain death, with few exceptions, it is unethical to maintain organ support. This decision may be considered in case of pregnancy to guarantee foetal viability and improve the perinatal outcome. We describe a case of prolonged organ support after brain death in a pregnant woman, following cardiac arrest secondary to an acute asthma attack. A 26-year-old primigravida, 18 weeks pregnant, with a history of stable asthma, was admitted to an ICU after cardiac arrest secondary to an acute asthma attack. It was possible to maintain organ support for 100 days with the collaboration of a multidisciplinary medical team. A healthy child was born, and favourable outcomes were observed at the 3-year follow-up. Brain death during pregnancy is a rare event and is a unique ethical, financial, and technical challenge. No guidelines are available for the management of these patients. This case demonstrates that it is possible to prolong organ support in this situation and successfully deliver a healthy child.